# An inflammation tracer that does not need a diet

Source: https://nuclide.cc/opportunities/opp-cardiac-sarcoidosis-specific-tracer/  
Nuclide record `opp-cardiac-sarcoidosis-specific-tracer` (Opportunity). Data CC BY-NC 4.0, attribute "Data from Nuclide (nuclide.cc)"; commercial use needs a licence.

## TL;DR

Deciding whether to put a patient on long-term steroids for heart sarcoidosis depends on a scan that only works if the patient's heart has been starved of sugar for a day, and a biopsy that misses the disease most of the time. A different tracer would not need the diet.

## Summary

Cardiac sarcoidosis is the case where the incumbent test's weakness is procedural rather than biological. FDG PET requires metabolic suppression of normal myocardium through a strict low-carbohydrate, high-fat preparation, and imperfect suppression produces false positives on which immunosuppression decisions are then made. The histological reference standard is worse: endomyocardial biopsy sensitivity is reported at approximately 20 to 30%, and elsewhere as less than 25%. There is no reliable serum biomarker for diagnosis, monitoring of inflammatory activity or severity. And the disease is substantially under-recognised: about 5% of sarcoidosis patients have clinically manifest cardiac involvement while autopsy series report 25% to 50%.

Somatostatin receptor tracers are the most developed alternative because macrophages in active granulomas express SSTR2, and no dietary preparation is needed. The evidence is consistent but small and mixed. A University of Pennsylvania study of 11 patients found 91% patient-level concordance with FDG but only 77.1% segment-level agreement, a lower signal-to-blood-pool ratio of 3.2 against 4.9, and underestimation of treatment response. A Würzburg 68Ga-DOTATOC study of 15 patients found SSTR-PET positive in 7 of 15 against cardiac MRI in 10 of 15. A 19-patient comparative study of 68Ga-DOTANOC has been reported at 100% diagnostic accuracy against 79% for FDG, while a 17-patient study found poorer agreement with MRI at 76.5%.

The practical attraction is that the tracer itself is already approved for another indication as NETSPOT, so manufacturing and dosimetry are de-risked; what is missing is a clinical package for this indication, and a completed 78-patient Swedish study with biopsy and MRI comparators is the largest dataset that could supply one.

## Fields

- Kind: Opportunity
- Last checked: 2026-09-23
- Also known as: SSTR PET in cardiac sarcoidosis
- Tags: unmet need first; cardiac; non-oncology; inflammation

## Sources

- 68Ga-DOTATATE against FDG in cardiac sarcoidosis, J Nucl Cardiol 2023: https://link.springer.com/article/10.1007/s12350-022-03111-4
- NCT04206163: somatostatin receptor imaging in inflammatory heart disease, 78 patients: https://clinicaltrials.gov/study/NCT04206163
- No reliable serum biomarker in sarcoidosis, JACC state-of-the-art review: https://www.jacc.org/doi/10.1016/j.jacc.2020.08.042
- Clinically manifest against autopsy prevalence, JAHA 2023: https://www.ahajournals.org/doi/10.1161/JAHA.122.028342
- 68Ga-DOTATOC compared with cardiac MRI, Oncotarget 2016: https://pmc.ncbi.nlm.nih.gov/articles/PMC5363622/

## Connected records

- isotopes: [Fluorine-18](https://nuclide.cc/isotopes/f-18/), [Gallium-68](https://nuclide.cc/isotopes/ga-68/)
- indications: [Cardiac sarcoidosis](https://nuclide.cc/indications/cardiac-sarcoidosis/)
- technologies: [FDG PET](https://nuclide.cc/technologies/fdg-pet/), [PET/CT](https://nuclide.cc/technologies/pet-ct/), [Somatostatin receptor PET (68Ga/64Cu-DOTATATE)](https://nuclide.cc/technologies/sstr-pet/)
- targets: [Somatostatin receptor 2](https://nuclide.cc/targets/sstr2/)
- drugs: [Fludeoxyglucose F-18 (FDG)](https://nuclide.cc/drugs/fludeoxyglucose-f18/), [Gallium-68 DOTATATE (and Cu-64 DOTATATE)](https://nuclide.cc/drugs/ga68-dotatate/), [Gallium-68 edotreotide (DOTATOC)](https://nuclide.cc/drugs/ga-68-dotatoc/)

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